Quarterly record of Medicare Part A and Part B claims

Stores Management Information about Medicare Part C & Part D data for premiums and Medicare Part D Prescription Drug Subsidy processing and workload management data.

This blog post was posted on May 6, 2016.

Quarterly update of Medicare Part C and Part D benefit system

The Medicare Part D Prescribers by Provider dataset contains information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The dataset identifies providers by their National Provider Identifier (NPI) and summarizes for each prescriber the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost.

The Medicare Part D Prescribers by Provider and Drug dataset provides information on prescription drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other health care providers. This dataset contains the total number of prescription fills that were dispensed and the total drug cost paid organized by prescribing National Provider Identifier (NPI), drug brand name (if applicable) and drug generic name.

This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by managed care participation (comprehensive managed care, primary care case management, MLTSS, including PACE, behavioral health organizations, nonmedical prepaid health plans, medical-only prepaid health plans, and other). There are three metrics presented: (1) the number of beneficiaries ever enrolled in each managed care plan type over the year (duplicated count); (2) the number of beneficiaries enrolled in each managed care plan type as of an individual’s last month of enrollment (duplicated count); and (3) average monthly enrollment in each managed care plan type. These metrics are based on data in the T-MSIS Analytic Files (TAF). Some cells have a value of “DS”. Some states have serious data quality issues, making the data unusable for calculating these measures. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state and year are considered unusable or of high concern based on DQ Atlas thresholds for the topics Enrollment in CMC, Enrollment in PCCM Programs, and Enrollment in BHO Plans. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

본인이 부담한 비용의 총액이 상한액을 넘는 경우 그 초과액을 공단이 부담하며, 사전급여와 사후환급으로 구분됩니다. 사전급여란 연간 같은 요양기관에서 진료를 받고 최고 상한액을 초과하면 요양기관이 그 초과액을 공단에 청구하여 지급 받는 것이며, 사후환급은 본인부담 총액이 상한액을 넘었으나 사전급여를 받지 않은 경우 공단이 그 초과액을 현금으로 지급하는 것입니다.

o (내용) 건강검진 종별 대상자 구축 내역 o (대상) 당해연도 건강검진 종별 중 하나라도 대상자인 건강보험 가입자 o (변수 레이아웃) 1 사업년도 2 분류명(대상자 구축 단계) 3 건수 o (자료제공범위) 자료가 존재하는 범위 내 가장 최근 ‘1개월’ (2022년12월1일~2022년12월30일), 6행 이상 제공 불가